Bedside Shift Change vs. Nurse-to-Nurse Reporting

Introduction

The reporting mechanism, which a healthcare institution employs in communicating patients’ information among healthcare personnel during a change of shift, determines the quality of nursing care that patients receive. A communication breakdown or inaccurate transfer of information among different healthcare providers has a detrimental impact on the nature of patient care. According to Alvarado, et al. (2006), the Joint Commission on Accreditation of Healthcare Organizations has found out that, about 70 percent of sentinel cases occur due to communication breakdown among healthcare providers during change of shift. Hence, effective communication during change of shift or shift handover is essential to improve the quality of care that patients receive and promote professionalism in nursing. Insufficient or inaccurate communication affects the delivery of healthcare, as providers are unable to track the prognosis process of patients, thus contributing to negligence and poor transfer of accountability. Moreover, variation in the mechanism of transfer of accountability among different healthcare providers poses challenges in the transfer of accurate and reliable information that reflects the condition of patients. Therefore, this essay compares the effect of nurse-to-nurse bedside shift change reporting versus traditional nurse-to-nurse reporting with a view of examining the safety and satisfaction of adult patients.

Database and Key Words

In search of appropriate literature material, the United States Library of Medicine (PubMed), National Center for Biotechnology, Association of Rehabilitation Nurses, and Vanderbilt University Library provided the articles for the study. Keywords used during the search of literature material include – nurse-to-nurse bedside shift, traditional nurse-to-nurse reporting, patient participation, transfer of accountability, and change of shift reports.

Evaluation of Evidence

This essay reviews three articles and evaluates them according to the proposed evidence-based practice project question (PICO question): “What is the effect of nurse-to-nurse bedside shift change reporting versus traditional nurse-to-nurse reporting about adult patient satisfaction?” The titles of these articles are “Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety” by Alvarado, et al. (2006), “Nurse Shift Report: Who Says You Can’t Talk in Front of the Patient?” by Anderson and Mangino (2006), and “Incorporating Bedside Reporting into Change-of-Shift Report” by Laws and Amato (2010). The essay provides a review of each of the above articles respectively.

Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety

According to Alvarado, et al. (2006), one of the most crucial components of patient care is the mechanism under which healthcare providers transfer information when changing shifts. Communication among healthcare providers helps in planning for patient care, recognizing safety threats, and enhancing the continuity of information. The study focuses on the implementation of Transfer of Accountability (TOA) guidelines in five hospital units of Hamilton Health Sciences (HHS). It uses the human caring theory by Jean Watson as a framework of TOA. The theory perceives transpersonal relationships as having a healing potential for both patients and caregivers. Moreover, it postulates that patients are an integral part of nursing, and thus nurses should not treat them as passive objects or isolate them from nursing care as in the case of traditional change of shift. Thus, the objectives of the article were to review current processes of shift handover at HHS, formulate TOA guidelines, and implement TOA guidelines with a view of promoting patient safety and satisfaction.

The researchers conducted the study at Hamilton Health Science (HHS), which is a tertiary care facility with 1,000 beds and serves over 2 million residents. Before the implementation of the TOA project, the study reviewed current shift handover practices that nurses employed when changing shifts at HHS. Out of 52 clinical units issued with surveys, only 36 clinical units managed to respond. The surveys revealed that healthcare providers use various techniques in shift handover, which include a mixture of verbal, written, and taped mechanisms. The handover time “ranged from one to two minutes for patients inwards, and six minutes for patients in critical care” (Alvarado, et al., 2006, p. 78).

In the formulation of TOA guidelines, a panel of experts that include clinicians, educators, and administrators in nursing reviewed essential articles and made their contributions. According to Alvarado, et al. (2006), TOA guidelines have three phases, viz. “pre-handover, inter-shift handover, and post-handover” (p.76). The completion of TOA guidelines led to a pilot study, “which involved two clinical inpatient units, a 16-bed general medicine unit, and a 34-bed obstetrical unit” (Alvarado, et al., 2006, p.78). The nurses learned about TOA requirements before receiving an essential information package on each unit. They received support through both email and telephone. After four months, an assessment made through analysis of questionnaire using t-test revealed that nurses were not comfortable when transferring information at the bedside (Alvarado, et al., 2006). However, nurses preferred written documentation as means of transferring information.

The actual implementation plan of TOA guidelines involved the establishment of four guiding principles. The first principle provided a safety checklist for nurses to review the primary safety concerns and identify errors, while the second principle ensured that nurses conducted face-to-face dialogue to clarify the conveyed information. The third principle demanded nurses use a staff-written tool to avoid their reliance on memory, and the fourth principle demanded that one of the nurses should have a full picture of the unit by using a charge-nurse written tool (Alvarado, et al., 2006). Thus, the four principles guided nurses in implementing the TOA guidelines. Consequently, the implementation of TOA guidelines led to improved patient safety and patient satisfaction.

Nurse Shift Report: Who Says You Can’t Talk in Front of the Patient?

The article by Anderson and Mangino (2006) examines the challenges faced by healthcare providers when implementing traditional communication techniques. The authors acknowledge the increasing level of complexity of medical information, technology, customer demands, and expectations in the delivery of healthcare. Traditional communication techniques include taped and verbal reports; however, patients perceive the techniques as unsatisfactory since they want to participate in their care plan. One way to satisfy consumer demands and market forces is to use bedside shift reports. The study employed Imogene King Bonnie’s theory of goal attainment, which views patients as components of systems interacting at “personal, interpersonal, and social levels” (Anderson & Mangino, 2006, p. 112). The goal attainment theory provides a framework of how relationships among nurses, patients, and other healthcare providers occur. Bedside shift reporting involves patients in decision making, which builds the relationship between staff members whilst increasing patient satisfaction in the treatment process.

The researchers conducted the study on one of the Adult Acute Care units at the Banner Desert Medical Center (BDMC). The study implemented bedside shift reporting on the general surgical unit because of their willingness to adapt to new techniques. The implementation process comprised of staff information and fragmentary responses and assessment. Caregivers were educated on “how to introduce the oncoming team and report process to the patient, report content, maintaining patient privacy, exit statements, and how to address unusual circumstances” (Anderson & Mangino, 2006, p.116). The first step involved the identification of leaders at both management and nurse unit levels, who would help to enforce the bedside report process. The second step involved the identification of goals and outcomes of implementing bedside nurse reports.

The evaluation process involved monthly assessments of patient satisfaction scores. The variables used to measure the impact of bedside nurse reports were staff satisfaction and patient satisfaction. Surveys conducted determined the level of staff and patient satisfaction before and after implementation of bedside nurse report. According to Anderson & Mangino (2006), there was minimal resistance during the implementation of bedside reporting. Hence, the study proved the hypothesis that bedside shift reporting enhances the collaboration of nurses and patients, which enhances the satisfaction of both patients and caregivers.

Incorporating Bedside Reporting into Change-of-Shift Report

According to Laws and Amato (2010), there are many instances of communication failure during shift reports, which touch on patient safety. The authors acknowledge the significance of the 2007 National Patient Safety Goals for Hospitals, which aim at developing communication between caregivers during the change-of-shift reporting. Bonnie’s theory of humanistic communication forms the framework because the study examines how interaction among nurses, patients, and other caregivers improves patient safety and satisfaction. According to Laws and Amato (2010), the availability of massive information on the Internet, radio, and television has made patients gain enough knowledge about their health, and thus they are ready to contribute in decisions touching on their healthcare issues. Hence, the study involves the assessment of the implementation of a bedside change-of-shift reporting process at a stroke rehabilitation unit about patient safety and patient satisfaction.

The implementation of bedside reporting on the stroke rehabilitation unit occurred following the suggestions by the Joint Commission that effective hand-off communication should include “current information regarding the patient’s care, treatment and services, current condition, and any recent or anticipated changes” (Laws & Amato, 2010, p.71). However, the stroke rehabilitation unit experienced a communication breakdown, resulting in serious implications due to the transfer of inaccurate information. Before the implementation of bedside reporting, researchers were surveyed to identify their concerns about the rehabilitation system. From surveys, issues raised involved patient confidentiality and extended duration of reports due to inquiries from patients.

Implementation of the bedside reporting involved the creation of a team to support in administrating and guiding the nurses. The nurses used a standardized reporting sheet as the source of patient data to ensure data consistency. A survey administered to the nurses after four months of the bedside-reporting process indicated that the new reporting method enhanced patient safety and satisfaction, as well as improved nurse satisfaction (Laws & Amato, 2010). The nurses reported that the system enhanced their accountability during shifts, which helped to reassure patients that they were always in safe hands, thus increasing their safety and satisfaction.

The study noted that bedside reporting was “effective for both day and evening shifts; however, nurses recorded verbal reports for night shifts without involving patients because they were sleeping and did not want to disturb them” (Laws & Amato, 2010, p.73). The study also indicated that the caregivers needed a short report time, away from the patient, to discuss sensitive issues. Hence, the study proved that bedside reporting enhances patient safety and satisfaction due to patient collaboration in their care

Recommendation

Healthcare institutions should abandon the traditional-change-of-shift reporting and adopt bedside-shift reporting because the latter has a significant impact in improving the quality of care and enhancing patient satisfaction. Since adult patients have basic information about their health, bedside reporting allows them to participate in the decision-making process regarding their healthcare issues.

Plan for Implementation

Implementation of bedside reporting guidelines in health institutions requires the participation of all healthcare professionals. Since the literature review indicated that healthcare professionals are uncomfortable sharing information of patients in their presence, some training is necessary to dispel fears that prevent providers from implementing bedside shift reporting. Ethics also play a critical role in the implementation of bedside shift guidelines because information about patients is very sensitive.

Expected Outcomes

Overall, bedside shift reporting enhances the quality of care that patients receive, thus leading to improved safety and satisfaction among patients. Moreover, bedside reporting enhances accountability on the part of healthcare providers, which ultimately improves satisfaction like the work that they perform.

Method of Evaluation

Comparison of traditional shift reporting and bedside shift reporting provides an effective means of evaluating the impact of bedside shift reporting on patient safety and satisfaction. Implementation of bedside shift reporting would result in changes in communication patterns among healthcare providers and increased participation of patients in their healthcare plan.

Conclusion

When compared with the traditional change of shift report, bedside reporting is effective in improving safety and satisfaction among adult patients. Laws and Amato posit, “Bedside reporting provides an opportunity for patients to participate in the planning of their healthcare” (2010, p.72). Participation of patients is possible because adult patients have basic information that enables them to contribute to the decision-making process regarding their care. Ample evidence indicates that bedside reporting does not only enhance satisfaction among patients, but it also promotes accountability and satisfaction among nurses as they provide healthcare services to patients. Hence, both the nurses and patients benefit from bedside reporting.

References

Alvarado, K., Lee, R., Christoffersen, E., Fram, N., Boblin, S., Poole, N.. Lucas, J., & Forsyth, S. (2006). Transfer of Accountability: Transforming Shift Handover to Enhance Patient Safety. Healthcare Quarterly, 9, 75-79.

Anderson, C. D., & Mangino, R. R. (2006). Nurse Shift Report: Who Says You Can’t Talk in Front of the Patient? Nurs Admin, 30(2), 112–122.

Laws, D., & Amato, S. (2010). Incorporating Bedside Reporting into Change-of-Shift Report. Rehabilitation Nursing, 35(2), 70-75.

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